POS1406 EVALUATING THE QUALITY OF CARE FOR HEART FAILURE HOSPITALIZATIONS IN INFLAMMATORY ARTHRITIS- A POPULATION-BASED COHORT STUDY
Authors: B. Kuriya, L. Eder, J. Widdifield, L. Ferreira-Legere, I. J. Jeong, J. Fang, A. Chu, J. Udell
Journal: Annals of the Rheumatic Diseases (2022)

Background Individuals with inflammatory arthritis (IA) have an increased risk of heart failure (HF). Little is known if the quality of HF care differs among patients with IA compared to other chronic diseases such as diabetes mellitus (DM). Objectives We examined adherence to quality-of-care indicators for HF hospitalizations among patients with IA compared to those with DM but no IA and the general population (without IA or DM). Methods We linked multiple population-based health datasets to construct a cohort of adults living in Ontario, Canada on January 1, 2011 and followed to December 2020. The IA cohort was identified using validated case definitions and included patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Comparison cohorts included adults with DM but no IA and general comparators without DM or IA. We included all subjects with a first HF hospitalization and who were alive at the time of discharge. We summarized the percentage of subjects in each of the 3 exposure groups who achieved recommended quality process measures [1]: (1) % receiving echocardiogram, (2) % receiving electrocardiogram, (3) % receiving a chest x-ray; and (4) % seen by a physician within 7 days of discharge. For those over the age of 65 years in whom medication information was universally available, we examined how many were dispensed evidence-based therapies: (5) % prescribed β-blocker, (6) % prescribed angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, (7) % prescribed mineralocorticoid receptor antagonist. We categorized adherence as perfect, moderate, or poor based on the number of measures achieved and compared proportions using pair-wise chi-squared tests. Results A first HF hospitalization occurred in 5,836 IA patients, 33,553 DM patients and 62,256 general comparators. The crude incidence rate for HF in IA was 2.70 per 1000/PY and was significantly higher compared to the general population (0.84 per 1000/PY), but lower compared to the DM cohort (5.01 per 1000/PY, p&lt; 0.001). Mean age at time of HF hospitalization was significantly higher in the IA group (78 years) with more females affected (58%) compared to either the DM or general population group (p&lt;0.001). All groups had high achievement of testing process measures and there were no differences in perfect adherence between the IA vs. DM and IA vs. general population comparators (Table 1). For those &gt;65 years of age, patients with IA were less likely to achieve perfect adherence for medication quality indicators compared to either the DM or general population. Table 1. Percentage in each of three exposure groups achieving the recommended HF quality measures. Process Measure IA Group DM Group General Population 1.Echocardiogram 90.6% 91.1% 89.5% 2.Electrocardiogram 97.4% 97.4% 97.3% 3.Chest x-ray 99.7% 99.6% 99.6% 4.Health care provider visit within 7 days of discharge 39.0% 38.9% 38.7% Perfect Adherence (achieving 1, 2,3 and 4 above) 33.0% 33.0% (p=0.43, IA vs. DM) 32.2% (p=0.15, IA vs general population) 5.Beta-blocker prescribed 64.8% 70.5% 66.6% 6.Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker prescribed 54.8% 61.3% 56.2% 7.Mineralocorticoid receptor antagonist prescribed 20.3% 19.9% 21.2% Perfect Adherence (achieving 5, 6 and 7 above) 10.6% 12.0% (p=&lt;0.001, IA vs. DM) 12.0% (p=0.02, IA vs general population) Conclusion HF quality indicators are adhered to in a high proportion of patients with IA following HF hospitalization. However, reasons for lower HF medication prescribing in IA compared to other high-risk conditions, such as DM, requires further evaluation. It will also be important to determine if adherence to HF quality of care translates to reduced long-term outcomes such as repeat HF hospitalizations and cardiovascular mortality, which we are currently exploring. References [1]Ontario HQ. Recommendations for Adoption: Heart Failure Care in the Community 2019 [Available from: http://www.hqontario.ca/Evidence-to-Improve-Care/Quality-Standards Disclosure of Interests Bindee Kuriya Speakers bureau: Abbvie, Gilead, Pfizer, Lihi Eder Speakers bureau: Abbvie, UCB, Pfizer, Eli Lily, Novartis and Sandoz, Jessica Widdifield: None declared, Laura Ferreira-Legere: None declared, Irene JH Jeong: None declared, Jiming Fang: None declared, Anna Chu: None declared, Jacob Udell: None declared